This report describes 20 premature infants who have undergone surgical ligation of a patent ductus arteriosus (PDA), diagnosed solely by physical examination in all but 2 instances. There were no operative deaths. Eleven of these 20 infants had severe associated hyaline membrane disease (HMD) necessitating mechanical ventilatory support from the first or second day of life. Only 3 of these 11 infants (27%) ultimately survived to leave the hospital. In contrast, 8 of 9 premature meonates (89%) with severe congestive heart failure but without HMD were discharged alive. Surgical ligation of the PDA in a premature infant is an appropriate and successful mode of treatment when congestive heart failure is refractory to medical management. Proof is lacking, however, to establish the efficacy of PDA ligation in the premature infant with HMD.

Cardiac Catheterization↗

PubMed1976

Pharmacists at America's first hospital, 1752-1841.

The development of the role of the apothecary at America's first hospital, the Pennsylvania Hospital, is presented. The first salaried apothecary, Jonathan Roberts, was hired in 1752. Subsequent apothecaries included students of medicine and surgery, some of whom worked for the benefit of experience, plus room and board. In an attempt to upgrade the position, an apothecary from England, with training in chemistry, was hired in 1768. During the Colonial period, the hospital pharmacist, in addition to preparing drugs, sometimes acted as resident physician, steward and even as an instructor to the apprentices. Drugs for the hospital were purchased from England until the American Revolution. While the function of the apothecary was absorbed by the resident apprentices during the post-Revolutionary War period, the early 19th century brought the return of the professional apothecary whose sole function was to prepare prescriptions under the direction of the physicians.

History, 19th Century↗

PubMed1975

Role of coronary artery surgery in patients surviving unexpected cardiac arrest.

During the past 3-1/2 years, 101 of 199 patients who were successfully resuscitated by fire rescue squads in the community after unexpected cardiac arrest (documented ventricular fibrillation--VF) were admitted to the hospital. Forty-two of these patients ultimately were discharged from the hospital. However, the intermediate and long-term results were disappointing, for their mean survival after discharge was only 12.7 months. Sudden deaths (recurrent unexpected VF) occurred during the first 12 months after discharge in 28 percent of the patients surviving the initial hospitalization. Among the survivors of sudden and unexpected VF (i.e., survivors of the initial hospitalization), 16 patients who had had pre-existing symptoms of coronary heart disease had hemodynamic and coronary angiographic studies. Of these, 11 were considered surgical candidates. This report concerns the follow-up results in these patients with particular emphasis on the eight patients who accepted surgery and had myocardial revascularization. Five patients had moderate hemodynamic abnormalities, but none had had an acute myocardial infarction at the time of the initial arrest. The group of eight patients had a total of 18 vein graft bypasses performed. The significant findings is that all eight survived operation, and there was one late death at 10 months. The remaining patients are alive at 14 to 34 months, and six are free of symptoms. Despite patent vein grafts, one patient has had a second serious arrhythmia. It is concluded that surgical intervention can be done safely and may decrease the high posthospitalization, recurrent arrest, and mortality rates in selected survivors of unexpected cardiac arrest. It is concluded further that all patients sustaining an unexpected arrest should have postarrest coronary catheterization and angiography, and all patients should be on antiarrhythmic agents whether or not they receive myocardial revascularization.

Adult↗

PubMed1974